Majority of hip-fracture patients left in ED for more than four hours

Just over one-in-three patients with a hip fracture were admitted to an orthopaedic ward or the operating theatre within four hours of arrival at hospital last year, a new report reveals.

While the statistic is an improvement of seven percentage points in 2023 and 15 points higher than 2024, the ability of hospitals to act speedily in the care of hip fracture patients varies considerably by clinical site.

The Irish Hip Fractures Database (IHFD) National Report found that 36 per cent of these patients were transferred for surgery or to an orthopaedic ward within four hours of presenting to an emergency department (ED) in 2024.

However, in Letterkenny University Hospital, this rate was just two per cent, down from six per cent in 2023. In Galway University Hospital, the rate was six per cent in 2024, up from three per cent the previous year.

In contrast, 68 per cent of hip fracture patients in Dublin’s St James’s Hospital were sent to a ward or for surgery within four hours of arrival. In Kerry University Hospital the rate was 65 per cent – a 31 percentage-point increase on 2023.

Of those patients who experienced delays in the transfer of care away from the ED, a lack of available ward beds was the cause of this wait in just over one-in-five cases (21 per cent).

One-in-ten delays were due to patients left waiting for an orthopaedic diagnosis or clinical investigation. However, in 47 per cent of cases no reason was given for the patients’ waits, suggesting that staffing and capacity issues may play a larger role in delayed care than these figures show.

The vast majority of people with a hip fracture last year went on to have surgery (96 per cent). Over three-in-four of these operations (77 per cent) took place within 48 hours of the fracture – two per cent higher than in 2023, but still below the HSE national target of 85 per cent.

In 2024, 62 per cent of surgeries were carried out by a consultant orthopaedic surgeon, and 28 per cent were carried out by a specialist registrar. The main causes of delay to surgery were ‘issues due to anticoagulation’ (20 per cent) and ‘awaiting medical review, investigation or stabilisation’ (20 per cent).

The consequences of delayed care are laid out in detail when it comes to those patients who went on to develop a pressure ulcer during admission. There were 150 of these cases recorded last year, representing four per cent of hip fracture patients.

However, of those 150, just 14 per cent were admitted to an orthopaedic ward or the operating theatre within four hours of first presentation, while just 16 per cent had surgery within 48 hours of hospital arrival.

The report recommends a renewed focus on pressure ulcer prevention and education, particularly noting that ulcer rates have increased in the last two years, having been at three per cent per annum over a six-year period.

Other key areas of focus for the future include nutritional and delirium screening. Last year 71 per cent of hip fracture patients received a nutritional risk assessment, while just over half (54 per cent) received a delirium screening assessment within one day of their hospital admission.

“This year’s findings show sustained progress in the timeliness and quality of hip fracture care, supported by the dedication of teams nationwide,” said Mr Terence Murphy, National Clinical Orthopaedic Lead of the IHFD.

“However, consistency remains our biggest challenge. We must continue to focus on access to timely surgery, prevention of pressure ulcers and equitable access to specialist care.

“To truly enhance outcomes, we must now strengthen our follow-up data and ensure every patient benefits from coordinated, multidisciplinary recovery planning.”

The report, published today by the National Office of Clinical Audit (NOCA) also found that 86 per cent of hip fracture patients were reviewed by a geriatrician or advanced nurse practitioner during admission.

A similar proportion (87 per cent) received a specialist falls assessment and 90 per cent underwent a bone-health assessment.

Fewer than one per cent of patients had a documented surgical site infection, while 84 per cent received a pre-operative nerve block for pain management and 85 per cent were mobilised by a physiotherapist on the day of, or the day after, surgery.